Increasing Utilization and Excellent Initial Outcomes Following Liver Transplant of Hepatitis C Virus (HCV)-Viremic Donors Into HCV-Negative Recipients: Outcomes Following Liver Transplant of HCV-Viremic Donors

Direct-acting antiviral (DAA) therapy has altered the frequency and outcome of liver transplantation (LT) for hepatitis C virus (HCV). The high efficacy and tolerability of DAA therapy has also created a rationale for utilizing HCV-viremic (HCV-RNA-positive) donors, including into HCV-negative recipients. We examined trends in frequency of organ utilization and graft survival in recipients of HCV-viremic donors (HCV-RNA positive as measured by nucleic acid testing [NAT]). Data were collected from the Scientific Registry of Transplant Recipients (SRTR) on adult patients who underwent a primary, single-organ, deceased donor LT from January 1, 2008 to January 31, 2018. Outcomes of HCV-negative transplant recipients (R-) who received an allograft from donors who were HCV-RNA positive (DNAT(+)) were compared to outcomes for R- patients who received organs from donors who were HCV-RNA negative (DNAT(-)). There were 11,270 DNAT(-)/R-; 4,748 DNAT(-)/R+; 87 DNAT(+)/R-; and 753 DNAT(+)/R+ patients, with 2-year graft survival similar across all groups: DNAT(-)/R- 88%; DNAT(-)/R+ 88%; DNAT(+)/R- 86%; and DNAT(+)/R+ 90%. Additionally, there were 2,635 LTs using HCV antibody-positive donors (DAb(+)): 2,378 DAb(+)/R+ and 257 DAb(+)/R-. The annual number of DAb(+)/R- transplants increased from seven in 2008 to 107 in 2017. In the post-DAA era, graft survival improved for all recipients, with 3-year survival of DAb(+)/R- patients and DAb(+)/R+ patients increasing to 88% from 79% and to 85% from 78%, respectively. Conclusion: The post-DAA era has seen increased utilization of HCV-viremic donor livers, including HCV-viremic livers into HCV-negative recipients. Early graft outcomes are similar to those of HCV-negative recipients. These results support utilization of HCV-viremic organs in selected recipients both with and without HCV infection.